Intestinal Obstruction Management

- Introduction

Intestinal obstruction is a critical surgical emergency that requires timely and effective management to prevent complications such as ischemia, perforation, sepsis, and mortality. Acute intestinal obstruction occurs when a mechanical obstruction disrupts or blocks the normal movement of intestinal contents. It is estimated to affect 2% to 8% of patients who visit the emergency department. While the rates of morbidity and mortality related to acute intestinal obstruction have decreased, managing the condition remains complex. The choice between non- operative management and surgical intervention should be made cautiously by skilled healthcare providers, ⁽¹⁾. The primary causes of acute intestinal obstruction are adhesions, neoplasms, and herniation. Adhesions, typically resulting from previous abdominal surgeries, are the leading cause of small bowel obstruction (SBO), responsible for 60% to 75% of cases. Lower abdominal and pelvic surgeries, such as appendectomy, colorectal, gynecologic surgeries, and hernia repairs, carry a higher risk of adhesive SBO. Obstructions caused by neoplasms are uncommon and are more frequently seen in the large bowel. Other potential causes include inflammatory bowel disease, intestinal intussusception, volvulus, intra-abdominal collections, gallstones, and foreign bodies, ⁽²⁾. This document serves as a comprehensive guideline for surgeons, providing an evidence-based approach to the classification, diagnosis, and treatment of intestinal obstruction.